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Erschienen in:
01.11.2015 | Original Article
Changes in urodynamic measurements and bladder neck position after single-incision trans-vaginal mesh for pelvic organ prolapse
Erschienen in: International Urogynecology Journal | Ausgabe 11/2015
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Introduction and hypothesis
Stress urinary incontinence (SUI) is common in patients with pelvic organ prolapse. This study hypothesized that SUI may be persistent, de novo, or even cured in women after Elevate™ mesh repair alone and that SUI is associated with urodynamic changes and bladder neck position.
Methods
This secondary analysis included a study cohort of 100 women who underwent Elevate™ repair. All of them underwent multi-channel urodynamic measurements, 1-h pad test, and bead chain urethrocystography to measure the bladder neck position pre-operatively and at 3 months post-surgery.
Results
Fifty-five women with pelvic organ prolapse were continent and 45 had concomitant SUI. Of the 55 continent women, 19 (35 %) had de novo SUI after mesh repair surgery and 5 (9 %) subsequently underwent anti-incontinence surgery. Of the 45 incontinent women, 11 (24 %) became dry after mesh repair without additional anti-incontinence surgery. Of the remaining 34 (76 %) with persistent SUI, 15 (33 %) underwent subsequent anti-incontinence surgery. Patients with de novo and persistent SUI had a greater decrease in maximal urethral closure pressure (MUCP) after mesh repair (p = 0.03 and 0.01 respectively). Those cured of SUI also had decreased MUCP (p = 0.12), but the bladder neck position while straining was significantly more elevated after mesh repair (p < 0.01) compared with those with persistent SUI.
Conclusions
Elevate™ mesh reinforcement significantly decreases post-operative MUCP, which is associated with SUI, but can elevate the bladder neck position. Correcting a hyper-mobile urethra is associated with treatment of the concomitant SUI.